State of Pain

Fayzen Woods simply wanted to get rid of her toothache. Then she had to deal with Missouri's Medicaid mess. That's when the real suffering began.

Fayzen Woods never thought much about her teeth. They were all there and in good shape, so when she woke up last July with what felt like a jackhammer pounding away at her jaw, she didn't know what to do.

This was not a good way to start off the week. Woods was scheduled to start a summer class and was supposed to take a physical for a second job driving a bus that would, with luck, see her through the next several months. Because she would be laid off from her regular job, driving a school bus, until September, she needed the extra income until starting back in fall.

The fact that her ex-husband had lost his job at Boeing didn't help matters much. The child-support payments were virtually nonexistent these days, so, between that and her summer break from work, Woods decided to apply for Medicaid. It was just a backup plan, in case she didn't get the summer job, but she wasn't too worried, because she had never had trouble getting work before.

Jennifer Silverberg

Fayzen Woods with her children, Tamia, Stephen and Damien. When Woods was broke and needed gas in the car, Damien offered up a $10 bill someone had sent him for his birthday. "He told me I should take it," she says.

And it wasn't as if she was asking for cash assistance. She didn't want any handouts. She'd get a job flipping burgers if she had to, but there wasn't a minimum-wage job out there that would pay for her family's health insurance, and there were the three kids -- Tamia, 9; Damien, 11; and Stephen, 15 -- to think about, after all.

Applying for Medicaid was no easy matter for Woods. There were offices to find, lines to stand in, forms to fill out. She had to provide this, verify that, calculate these and double check those. Was she in income bracket A, B or C? Were her assets closer to D, E or F? Sign here, please. Thank you. And here. Thank you. And here. Thank you. She felt trapped in a maze of dotted lines.

It bothered Woods that she didn't understand any of it. All she knew was what her caseworker told her -- that she would be enrolled in one category of Medicaid and her children would be enrolled in another. Woods didn't try assessing the ins and outs of the coverage -- wished, in fact, that she didn't have to deal with any of this at all -- she had no insurance from her regular job driving a bus, so she had to stand in line.

But several weeks after Woods was approved to receive Medicaid, as she held her aching jaw in one hand and the telephone in the other, she was informed by her caseworker that dental care wasn't covered by the category of Medicaid she was enrolled in.

"I really didn't understand what was going on," Woods says. "I found out later that I had like four abscessed teeth, but all I knew was that I was in a lot of pain, and they were telling me to call another number. I didn't know what this other number was, but I called it."

The woman who picked up the phone was a social worker for something called the MC+ Consumer Advocacy Project. But Woods didn't know what this place was or why she was supposed to call. Frankly, she didn't care. If they could help cure the misery in her mouth, that was all that mattered. She could hardly stand the pain.

Five days went by, and the social worker called her back to tell her that Woods' caseworker had incorrectly placed her in the wrong category of Medicaid. The social worker, a nice woman who apologized a lot, said that she had called the Missouri Department of Social Services (DSS) over and over again but had just gotten word back from them that day. The social worker went on and on about things that Woods didn't quite understand -- stuff about "transitional Medicaid" and "MC+" and "time limits" -- and all Woods could think about was getting to a dentist. She couldn't eat or drink anything, and she'd already missed the physical she was supposed to take for her new job.

The social worker told Woods her category would be changed but that it would take a couple of weeks, so in the meantime she would be enrolled in yet another category. Then the social worker gave Woods the names of three oral surgeons from a list supplied to her by DSS. Woods immediately contacted all three, but none of them accepted patients in the category of Medicaid that she was enrolled in.

Woods phoned the social worker and was given the names of six more oral surgeons from the DSS list. When Woods contacted them, one had retired, four didn't accept clients in her Medicaid category and the sixth would take her only if she paid $160 up front for the anesthesia. As far as Woods was concerned, $160 could have been $1 million. She simply didn't have it.

So Woods called back the social worker, who said she'd try to find an oral surgeon. Three days later, the social worker got back to Woods with still more bad news: She had asked DSS for the names of oral surgeons in Jefferson, Franklin and St. Charles counties, but there was none in Jefferson and Franklin counties, and the only one in St. Charles wasn't accepting any more Medicaid clients, no matter what category they were in. The social worker told Woods that she would try to get her into the new category as soon as possible.